维持缓解的拉米夫定耐药患者对阿德福韦病毒学应答附加拉

StephenW

Viral Hepatitis
Maintaining remission in lamivudine-resistant patients with a virological response to adefovir add-on lamivudine after stopping lamivudine therapy

    Mi Na Kim1,2,3,
    Chun Kyon Lee4,
    Sang Hoon Ahn1,2,3,
    Sangheun Lee1,2,3,
    Seung Up Kim1,2,3,
    Do Young Kim1,2,3,
    Hyon Suk Kim5,
    Kwang-Hyub Han1,2,3,
    Chae Yoon Chon1,2,3 and
    Jun Yong Park1,2,3,*

Article first published online: 12 JAN 2014

DOI: 10.1111/liv.12437

© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Issue
Liver International
Volume 34, Issue 10, pages 1543–1549, November 2014


Abstract
Background & Aims

We examined the durability of the virological response after discontinuing lamivudine (LVD) in chronic hepatitis B (CHB) patients with LVD-resistant hepatitis B virus (HBV), who responded to LVD plus adefovir (ADV) combination therapy, and the outcome of switching to ADV monotherapy compared to maintaining combination therapy.
Methods

This study enrolled 72 patients with undetectable viral loads (≤12 IU/ml) and normal alanine aminotransferase levels after ADV add-on therapy for at least 6 months in LVD-resistant CHB patients. The enrolled patients were randomly assigned to continue with LVD–ADV combination therapy or switch to ADV monotherapy (n = 36 per group). Virological rebound was defined as HBV DNA detection at more than 12 IU/ml by quantitative polymerase chain reaction determined on two consecutive measurements.
Results

During 96 weeks of follow-up, 100% (36/36) of the patients in the LVD–ADV combination maintained group had persistently undetectable HBV DNA, compared with 94.4% (34/36) patients in the ADV monotherapy switched group. These two patients had undetectable HBV DNA after switching back to LVD–ADV combination therapy. There were no significant differences in the HBsAg levels between the two treatment groups during the 96-week follow-up period.
Conclusions

In our study, switching to ADV monotherapy resulted in sustained HBV DNA suppression in 94.4% of the patients for 96 weeks. Prior complete viral suppression with LVD–ADV combination therapy conferred a significant advantage in patients who switched to ADV monotherapy. LVD may be discontinued in patients who show a complete virological response to LVD–ADV combination therapy for at least 6 months.

StephenW

病毒性肝炎
维持缓解的拉米夫定耐药患者对阿德福韦病毒学应答附加拉米夫定停药拉米夫定治疗后

    宓嗯啊Kim1,2,3，
    春阿虚Lee4，
    桑勋Ahn1,2,3，
    Sangheun Lee1,2,3，
    升向上Kim1,2,3，
    难道年轻Kim1,2,3，
    玄淑Kim5，
    刘广Hyub Han1,2,3，
    蔡尹Chon1,2,3和
    君永Park1,2,3，*

文章首次发表时间：2014年1月12日

DOI：10.1111/ liv.12437

©2013年约翰·威利父子A / S。由John Wiley＆Sons出版公司

问题
国际肝病
第34卷，第10期，页1543至1549年，2014年11月


摘要
背景与目的

我们研究的病毒学应答的持久性中断拉米夫定（LVD）的慢性乙型肝炎（CHB）患者LVD耐药乙肝病毒（HBV），谁回答LVD加上阿德福韦（ADV）联合治疗，而切换后的结果以ADV单药治疗相比，维持联合治疗。
方法

该研究纳入72例患者检测不到病毒载量（≤12IU/ ml）和正常的谷丙转氨酶水平ADV后添加治疗至少6个月的LVD耐药慢性乙型肝炎患者。在参加试验的患者被随机分配到继续与LVD-ADV联合治疗或改用阿德福韦单药治疗（每组n =36）。病毒学反弹定义为HBV DNA的检测，在超过12个国际单位/毫升的，由两个连续测量确定定量聚合酶链式反应。
结果

在96周的患者随访中，100％（三十六分之三十六）在LVD-ADV组合保持组持续不到HBV DNA，以94.4％相比（36分之34）患者在ADV单一疗法交换基团。这两个病人切换回LVD-ADV联合治疗后检测不到乙肝病毒DNA。有在96周的随访期间，在两个治疗组之间的HBsAg水平没有显著差异。
结论

在我们的研究中，切换到ADV单药治疗导致持续的HBV DNA抑制在患者94.4％维持96周。在此之前完全抑制病毒与LVD-ADV联合治疗授予在谁改用阿德福韦单药治疗的患者显著优势。 LVD可能会停止在谁表现出完整的病毒学应答到LVD-ADV联合治疗至少6个月的患者。